Healthcare Provider Details

I. General information

NPI: 1255920062
Provider Name (Legal Business Name): J LEE MD MEDICAL CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 360
ORANGE CA
92868-4300
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 360
ORANGE CA
92868-4300
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-0492
  • Fax: 714-245-0496
Mailing address:
  • Phone: 714-245-0492
  • Fax: 714-245-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOO-HYUNG LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-245-0492